| Doctor Name: | MR. DONALD WILLIAM WISSUSIK |
| NPI Number: | 1063525756 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.A., M.S. |
| License Number: | T0082 |
| Business Practice Address: | 19185 Sw 90th Ave Tualatin, OR - 970627558 |
| Business Phone Number: | 5038857376 |
| Business Fax Number: | |
| Mailing Address: | 19185 Sw 90th Ave, TUALATIN |
| State: | OR |
| Postal Code: | 970627558 |
| Phone Number: | 5038857366 |
| Fax Number: | |
| NPI Enumeration Date: | 08/16/2006 |
| NPI Last Update Date: | 07/13/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | T0082 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |